Penile urethral diverticulum in a kid M. Doğa TEMİZSOYLU and Sırrı AVKİ* *Department of Surgery, Faculty of Veterinary Medicine, Akdeniz University, Burdur. Summary: A 16-day-old, male, crossbred kid was presented with a history of a poor suckling reflex, stranguria and dysuria. The owners noticed that the animal was vocalizing and straining to urinate. Physical examination revealed a narrowed urethral process and orifice that caused formation of a penile urethral diverticulum. The narrowed urethral process was removed with scissors. Penile urethral diverticulectomy was performed by the guidance of urethral catheter. Postoperatively, penile urethra and urethral orifice were both appeared to be healed without any complications, and the clinical problems observed preoperatively were recovered. Key words: Diverticulum, diverticulectomy, kid, stricture, urethral orifice. Bir oğlakta penil uretral divertikülüm Özet: Bu olgu sunumunu azalan emme refleksi, stranguri ve disuri hikayesi ile getirilen 16 günlük, melez, bir erkek oğlak oluşturdu. Hasta sahibi oğlağın idrarını zorlanarak ve bağırarak yaptığına dikkat çekti. Olgunun yapılan klinik muayenesinde processus uretralis ve deliğinin daralmış olduğu ve buna bağlı olarak da yaklaşık 4 cm çapında ve prepüsyal deliğin 2 cm kaudalinde penil uretral divertikülümün varlığı belirlendi. Daralmış olan processus uretralis makas ampute edildi. Üretral kateter rehberliğinde penil uretral divertikülektomi gerçekleştirildi. Postoperatif olarak, penil uretra ve uretral delik herhangi bir komplikasyon olmaksızın iyileştiği ve operasyon öncesi gözlenen klinik problemlerin sağaltıldığı görüldü. Anahtar kelimeler: Divertikülüm, divertikülektomi, oğlak, striktür, uretral delik.
2 A 16-day-old, male, crossbred goat kid was referred to the clinic of surgery, Faculty of Veterinary Medicine; University of Akdeniz, because of a poor suckling reflex, dysuria of 15 days duration and evaluation of a cyst-like structure on the prepuce. The owners noticed the animal was vocalizing and straining to urinate. The kid was depressed, tachycardic (120 beats per minute) but had a normal rectal temperature (39.1 o C). Results of physical examination were dribbling of urine from the prepuce and protruded glans penis and urethral process from the preputial sheath (Figure 1). The kid was restrained in dorsal recumbency; the preputial skin was retracted caudad by an assistant percutaneously. It was observed that the urethral process and glans penis was lightly adhered to the prepuce. The urethral orifice and process were narrowed. The most important finding was the penile urethral diverticulum, which was situated 2 cm caudal to the preputial orifice and measured 4 cm in diameter. No other abnormalities were detected in physical examination of the genitourinary system. Urine was voided from the external urethral orifice when the swelling was manually compressed. We were unable to catheterize the urethra due to narrowed urethral orifice. Dry chemical analysis of the urine revealed hemoglobinuria (4+), alkaluria (ph, 8.5). An ultrasound evaluation of the abdomen in transverse and sagittal planes did not demonstrate abnormalities in the fluid-filled bladder and there was no evidence of free fluid in the abdomen. Xylocaine jelly (2%) was applied topically to desensitize the prepuce and glans penis. The urethral process and glans penis were freed with gentle caudad traction of the prepuce. The narrowed urethral process was amputated with scissors and then the urine was spontaneously voided without difficulty. A lubricated sterile 3.5 F catheter was placed into the urethra. The kid was prepared for aseptic surgery. An intravenous catheter was placed in left jugular vein and lactated Ringer s solution (2 mg/kg/h) was administered during operation. Sedation and analgesia were provided by xylazine hydrochloride at 0.2 mg/kg, IM
3 and anesthesia was induced with ketamine hydrochloride at 10 mg/kg, IM. The kid was placed in dorsal recumbency. Penile urethral diverticulectomy was performed by the guidance of the urethral catheter. Utilizing fine scissors, a large elliptical skin and urethral mucosa was removed approximately up to the diameter of the intact urethra (Figure 2). Urethra and skin sutured with 4-0 polyglactin 910 (Vicryl) and 4-0 silk (Mersilk) in a simple interrupted pattern, respectively. The kid was injected with penicillin G procaine at a dose of 25.000 IU/kg/day, IM, for seven days. The urethral catheter was allowed to be in place for 8 days by suturing its tip to the preputial skin. Urethral catheter and surgical site were protected from self-mutilation by the patient with Elizabethan collar. On day 2, the kid s appetite and attitude had improved markedly and urination was normal. Eight days after surgery, urethral catheter and skin sutures were removed. Penile urethra and urethral orifice were both appeared to be healed without any complications, and the clinical problems observed preoperatively were recovered. At three months following surgery, a telephone conversation revealed that the kid was urinating normally and no adverse clinical or behavioral signs were reported. There are very few reports of urethral diverticulum in goats and kids (1,4,5). Congenital anomalies of the urinary system occur rarely in ruminants; however, a wide variety of anomalies may be encountered. A survey of urinary system defects in lambs revealed the following abnormalities: hipospadiasis and patent urachus (2). The most common defects seen are patent urachus, hypospadias, and renal agenesis. Defects are frequently present in multiples and are often seen with anomalies of other system. Hipospadiasis are found in association with hermaphroditism in goats; other defects are uncommon (3,6). No abnormalities such as cryptorchidism, hermaphroditism, dilated bladder, other than a narrowed urethral process and orifice that caused to formation of a penile urethral diverticulum were observed in a kid described in this report.
4 The urethral process is commonly amputated therapeutically and sometimes prophylactically in small ruminant breeding males (7). In our case, the penile urethral diverticulum was treated by diverticulectomy after amputation of the narrowed urethral process. The kid was discharged within 5 days, and was managed at home. This case suggests us that surgical correction of narrowed urethral orifice and urethral diverticulum result in successful treatment. References 1. Cruz-Arambulo RJ, Tan L, Callan RJ, Van Metre DJ, Park RD (2003): What is your diagnosis? [Communication between the urethra and corpus spongiosum, urethral stricture mild cystitis, and presence of a urethral diverticulum]. J Am Vet Med Assoc, 222,1211-1212. 2. Dennis SM (1979): Urogenital defects in sheep. Vet Rec, 105, 344-347. 3. Eaton ON (1943): An anatomical study of hermaphroditism in goats. Am J Vet Res, 4, 333-343. 4. Fuller DT, Baird AN, Morris EL, Kraemer DC (1992): What is your diagnosis? [Hypospadias and urethral diverticulum in goat]. J Am Vet Med Assoc, 201,1431-1432. 5. Karras S, Modransky P, Welker B (1992): Surgical correction of urethral dilation in an intersex goat. J Am Vet Med Assoc, 201, 1584-1586. 6. King WW, Young ME, Fox ME (2002): Multiple congenital genitourinary anomalies in a polled goat. Contemp Top Lab Anim Sci, 41, 39-42. 7. Smith MC (1994): Urinary System. 388-389. In: MC Smith, DM Sherman, (Eds). Goat Medicine. Lea & Febiger, Philadelphia.
5 Correspondence address: Yard. Doç. Dr. Mustafa Doğa TEMİZSOYLU Akdeniz Üniversitesi Veteriner Fakültesi, Cerrahi Anabilim Dalı, İstasyon Cad., 15100, Burdur. A B Figure 1. A- Close-up photograph of the protruded penis and proc. urethralis from the preputial sheath of the kid, B- Penil urethral diverticulum (double arrow) A B Figure 2. Photographs of the kid with the penile urethral diverticulum. A- Notice the urethral process which was narrowed and filled with urine (arrow), B- The dotted lines represent proposed incision for diverticulectomy.